What it is
Counterpressure uses a support person's palms, fists, or a tennis ball to apply firm, sustained pressure to the sacrum during each contraction. A related technique, the 'double hip squeeze,' compresses the hips inward with both hands to open the pelvic outlet. Both work well when the baby is posterior and the birthing person feels most of the pain in the low back.
Evidence review links
Each link opens the full review on the publisher's site in a new tab.
Possible benefits
- Immediate, dramatic relief for back labor in many peopleReview sources ↓
- Simple to teach; can be done by anyoneReview sources ↓
- No equipment requiredReview sources ↓
Possible risks
- Physically demanding for the support person over hoursReview sources ↓
- Not effective for everyoneReview sources ↓
Alternatives
- Warm compresses to the low backReview sources ↓
- Hydrotherapy (shower on low back)Review sources ↓
- Position changes (hands-and-knees, lunges)Review sources ↓
- TENS unitReview sources ↓
Current evidence
Cochrane review on hands-on pain management techniques finds modest but consistent reduction in pain and increased satisfaction with counterpressure and hip squeezes.
Where the evidence is clear · where people may choose differently
For most topics, guidelines from ACOG, WHO, and other major bodies broadly agree on the core safety points (when to act in an emergency, informed-consent standards, monitoring baselines). Where reasonable people — and even guidelines — differ tends to be around thresholds (when to start or stop something), preferences (comfort, environment, support), and values (how you weigh small risks against benefits). Use the questions below to explore those pieces with your care team.
Educational only. Your care team can help you weigh what applies to your specific situation.
Related evidence topics
- Massage in LaborLight or firm massage — foot, hand, shoulder, or lower back — as a comfort tool, especially in early and active labor.
- Rebozo TechniquesA traditional Mexican woven shawl used by midwives and doulas to sift, jiggle, and reposition — supporting relaxation and fetal alignment.
- Pain Management OptionsAn overview of non-pharmacologic and pharmacologic comfort options.
- Movement & Position in LaborFreedom to move, change positions, and use upright postures during labor.
Questions to ask your care team
- ?Can you teach my partner counterpressure and double hip squeeze?
- ?Are tennis balls, hot packs, or a rebozo available?
Universal questions (works for any decision)
A short BRAIN-style set you can bring to any conversation about interventions, monitoring, or care decisions.
- ?Why are you recommending this now — is it urgent, routine, or optional?
- ?What happens if we wait an hour (or longer) before deciding?
- ?What signs would tell us this is working — or that we need to change course?
- ?What are the alternatives, including doing nothing?
- ?What would you recommend if this were your family?
- ?What would change your recommendation?
Sources & provenance
Tap a source to open the original guideline or review in a new tab.
- Cochrane: Non-pharmacological interventions for pain relief in labour — Cochrane
- Evidence Based Birth: Comfort measures in labor — Evidence Based Birth
Plain-language paraphrase. Re-verify before publish.
Last reviewed: 2026-07-03
Further reading — canonical references
Read the source material directly. Each link opens the publisher's own current guidance in a new tab — cross-check what we summarize against what they say.
Tier 1 · Clinical guidelines
Tier 2 · Systematic reviews
Educational only. Guidelines evolve — the linked publisher pages will reflect newer guidance than any static snapshot.
Version history — v1.0.0
v1.0.0 · 2026-07-03 · LlaMamma editors
Initial counterpressure topic.
New guidance from ACOG, WHO, Evidence Based Birth, or other listed sources is recorded here and can be updated remotely without a new app release.